Blunt Eye Trauma

Isaac S Bruck, MD, PhD

Disclosures

November 04, 2013

In This Article

Case

Patient was a 36-year-old male who, while working on a construction site, was struck against the right eye by a piece of ejected reinforcement steel. He was wearing protective goggles at the time. Patient was brought to the ED via EMS complaining of right eye pain and loss of vision. Upon initial exam he was noted to have folding of the superior-lateral aspect of the iris, miosis and loss of visual acuity in the right eye. He was able to detect light sensation and had positive consensual accommodation. Seidel sign was negative as was fluorescein staining.

Figure 1.

Question

Patient arrives to your ED following blunt force trauma to the right eye with pain and decreased vision. Examination reveals moderate periorbital swelling, conjunctival hemorrhage and pupil as seen in the image above. Visual acuity is 20/30 in the left eye and light perception only in the right eye. Which of the following is the most appropriate management?

  1. Ocular ultrasound and emergency ophthalmology consultation

  2. Measure intraocular pressure and emergent ophthalmology consultation

  3. Timolol drops, intravenous acetazolamide and emergent ophthalmology consultation

  4. Eye shield, CT scan of the orbit and emergent ophthalmology consultation

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